25例肝炎相关再生障碍性贫血患者临床分析

目的探讨肝炎相关再生障碍性贫血(HAAA)患者发病时的临床特征、疗效及预后。方法回顾性分析2009年1月至2016年12月收治住院的25例HAAA患者发病时的临床特征、疗效及预后情况,并与同期特发性再生障碍性贫血(IAA)进行比较。结果 HAAA占同期AA比例的6.0%,HAAA患者的初诊中性粒细胞绝对计数(ANC)、网织红细胞(Ret)、淋巴细胞绝对计数(ALC)水平均低于IAA患者,差异有统计学意义(P<0.001),而早期感染率高于IAA患者,差异有统计学意义(44.0%与20.2%,P=0.005)。25例HAAA患者中,有7例(28.0%)接受抗胸腺细胞球蛋白(ATG)联合环孢素A(CSA)治疗,有效率71.4%(5/7例);7例(28.0%)接受造血干细胞移植(HSCT),有效率85.7%(6/7例)。5例患者因感染或出血早期死亡,早期病死率为20.0%(5/25例)。25例HAAA患者的5年总生存率为(75.3±8.8)%。结论HAAA相对少见,骨髓衰竭更为严重,早期感染率及早期病死率较高,应引起重视,及时予以有效的治疗。

Clinical Analysis of 25 Cases of Hepatitis Associated Aplastic Anemia

Objective To investigate the clinical characteristics,efficacy and prognosis of patients with hepatitis associated aplastic anemia( HAAA) at onset. Methods The clinical characteristics,curative effect and prognosis of 25 patients with HAAA admitted to our hospital from January 2009 to December 2016 were retrospectively analyzed and compared with those of idiopathic AA( IAA) during the same period.Results HAAA accounted for 6% of the proportion of AA in the same period.The first time diagnosis of absolute neutrophil count( ANC), reticulocyte count( Ret) and absolute lymphocyte count( ALC) of HAAA patients were lower than those of IAA patients( P = 0.004,0.014,<0.001),while the early infection rate was higher than that of IAA patients( 44.0% and 20.2%,P = 0.005).Of the 25 HAAA patients,7( 28.0%) received anti thymocyte globulin( ATG) combined with cyclosporine A( CSA) treatment,and the effective rate was 71.4%( 5/7 cases); 7 patients( 28%) received hematopoietic stem cell transplantation( HSCT),and the effective rate was 85.7%( 6/7 cases).5 patients died early due to infection or bleeding,and the early mortality rate was 20%( 5/25 cases). The 5 year overall survival rate of 25 patients with HAAA was( 75.3± 8. 8) %. Conclusion HAAA is relatively rare,bone marrow failure is more serious,early infection rate and early mortality rate is higher,which should be paid attention to and be treated effectively in time